The creation of an ostomy (stoma) is the therapy for many sufferers of disease or injury of the gastrointenstinal or urinary tract. An ostomy is a rerouting of the tract through an opening or stoma in the abdominal wall to the outside of the body. The term “ostomy” typically includes colostomy, ileostomy and urostomy. Once this opening has been created, the patient must use an ostomy appliance attached to their body by some means to capture or manage the body waste. This is typically done with a disposable ostomy pouch that is attached to the patient's peristomal area by means of an adhesive. A typical ostomy appliance consists of an ostomy pouch and an adhesive body fitment. In some examples, the pouch and body fitment are separate components whereby a replacement pouch can be removably attached to the body fitment while the same body fitment remains attached to the body at the stoma site. In other examples, the pouch and the body fitment are permanently attached together, and are applied to and removed from the stoma site as an integral unit.
Ideally, the stoma should protrude from the abdominal surface of the ostomate by a distance ranging from 0.5 cm to 2.5 cm. This protrusion forms a spout, from which effluent can discharge directly into the pouch. However, in many cases, the stoma protrudes by a lesser amount or not at all. For example, a “flush stoma” is a condition when the stoma reaches only as far as the surface of the abdomen; a “recessed stoma” is a condition when the stoma does not even reach the surface of the abdomen, and the peristomal skin is drawn into a funnel shaped mouth between the stoma and the abdominal surface. There are many potential causes for these conditions. These can include formation of the stoma with little or no protrusion by the surgeon; and post-operative weight gain by the ostomate. Post-operative weight gain causes the ostomate's abdominal region to expand in girth while the length of the intestine attached to the abdomen remains fixed, thereby resulting in the stoma being pulled toward and ultimately below the surface of the abdomen.
Flush and recessed stomas can be difficult to manage, because some effluent discharged from the stoma can tend to pool around the stoma, instead of the effluent discharging completely into the pouch. Stool retained in this manner can attack the interface between the adhesive body fitment and the ostomate's peristomal skin. Such attack reduces the adhesion of the body fitment to the skin, thereby reducing the effectiveness and the usable life of the appliance. The stool can also cause irritation and degradation of the peristomal skin itself. Stool exiting the stoma may contain digestive juices from the body, and such juices can attack the peristomal skin resulting in excoriation.
One current technique for dealing with a flush stoma and/or a recessed stoma is to use a body fitment with a convex pressure plate to apply increased local pressure to the skin immediately adjacent to the stoma. The increased pressure protrudes the stoma slightly, but a strong adhesion of the body fitment to the peristomal skin may be required to bear the reaction force.
U.S. Pat. No. 6,033,390 describes a continent ostomy port that includes a tube inserted into the stoma, and a closure for selectively closing a discharge channel within the tube. This device is for general stomas, and does not address the problem of recessed or flush stomas. A primary function of the device is to act as a controllable closure, for blocking discharge of effluent when desired by a user. However, the existence of the closure means that the tube inserted into the stoma has to form a strong seal against the stoma tissue, in order to withstand the pressure of effluent backing up inside the intestine, and to prevent such effluent from leaking between the stoma tissue and the inserted tube.
It may be desirable to provide an alternative technique for a flush stoma and/or a recessed stoma.